Provider Demographics
NPI:1154799294
Name:MENCER, LASA BREE (LMT)
Entity type:Individual
Prefix:
First Name:LASA
Middle Name:BREE
Last Name:MENCER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-1117
Mailing Address - Country:US
Mailing Address - Phone:304-402-8038
Mailing Address - Fax:
Practice Address - Street 1:106 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1117
Practice Address - Country:US
Practice Address - Phone:304-402-8038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-06
Last Update Date:2015-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2015-3357225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist